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Delayed reaction, biofilm formation after filler injection may decrease with preventive measures
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Preventable measures may help decrease delayed reactions and biofilm formation after dermal filler injection, according to findings from a literature review.
Researchers reviewed relevant literature to gain an understanding of and explore the mechanism of action for biofilm formation, diagnostic challenges and methods for recognizing biofilms.
The researchers explained that hyaluronic acid (HA) dermal fillers began becoming more popular due to a growing concern for patients’ reactions to bovine collagen dermal fillers and the inconvenience of having to perform hypersensitivity pretesting; however, because HA dermal fillers do not require hypersensitivity testing, reactions can occur weeks to months after the initial injection takes place. According to the researchers, one source found to be associated with delayed reactions is antigenic stimulation, tracing back to contaminants from the bacterial fermentation method used to produce HA fillers.
Infection associated with a filler can be difficult to diagnose with the use of conventional methodology, as traditional culturing techniques may not allow enough time for the incubation of slow-growing organisms, according to the researchers. Additionally, obtaining an accurate patient history to identify the potential for a delayed dermal filler reaction can also prove challenging if the patient is ignorant of what type of filler they were injected with or if they are non-forthcoming regarding injections performed at a discount center that may have involved fillers not approved for use in the U.S. However, options including computed tomography (CT) scan and magnetic resonance imaging (MRI) may be used to determine the presence and location of injected material if a diagnosis of dermal filler reaction is being considered.
Establishing the presence of biofilm formation can be achieved through the use of special stains such as Gram, Fite, periodic acid-Schiff and others; however, their absence is not enough to rule out an infection diagnosis, according to the researchers.
When a positive culture does not exist, evaluation using molecular techniques such as polymerase chain reaction (PCR) and fluorescent in situ hybridization (FISH) may also be of assistance. However, in many instances, the cultures, PCR and FISH fail to reveal a causative organism, according to the researchers. Histopathology may suggest a solely immune-mediated reaction, and for these patients, the researchers recommended considering hypersensitivity reactions.
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